Granulomatous Meningoencephalomyelitis (GME)
Granulomatous meningoencephalomyelitis (GME) is an inflammatory disease of the central nervous system (CNS) that leads to the formation of granuloma(s) -- a ball-like collection of immune cells formed when the immune system tries to wall off foreign substances -- which can be localized, diffused, or involving multiple locations, such as the brain, spinal cord and surrounding membranes (meninges).
This disease is the most well recognized and accepted CNS inflammatory disorder in dogs. However, dogs between the ages of 6 months and 10 years are most commonly affected with GME. And although both sexes can be affected, there is a slightly higher prevalence in females.
SYMPTOMS AND TYPES
The symptoms depend on the form of disease and its location. For example, theocular form of GME will affect the eye region, while multifocal GME will affect the brain or brain and spinal cord, and focal GME will focus singly on either the brain or spinal cord. Common symptoms associated with GME include:
- Behavioral changes
- Weakness of hind limbs (parapresis)
- Weakness of all four limbs (tetraparesis)
- Constant Head pressing against objects
The exact cause of GME is currently unknown.
You will need to give a thorough history of your dog’s health to your veterinarian, including the onset and nature of the symptoms. He or she will then perform a complete physical examination as well as a complete blood count, biochemistry profile, and urinalysis -- the results of which are typically within normal ranges unless an infection is present. In those cases, the white blood cell count will be abnormally elevated.
The preferred method for diagnosis, however, is an MRI (Magnetic Resonance Imaging) scan, which will reveal single, multiple, or well circumscribed lesions within the nervous system. Your veterinarian may also take a sample of cerebrospinal fluid, a nourishing fluid that circulates around the brain and spinal cord. Though not a good test to confirm a diagnosis of GME, it can confirm inflammation associated with the disease.
In addition, conducting a brain biopsy can help confirm GME, but it is rarely done due to the dangers involved with removing a small sample of brain tissue.
Often, immediate intensive care and hospitalization is required for dogs with severe forms of GME. For debilitated patients, intravenous fluid therapy is initiated to counter the body fluid deficits. Long-term steroid therapy, meanwhile, is used to alleviate the symptoms -- though never after the use of NSAIDs and only under the supervision of your veterinarian. In case of focal nature of disease, radiation therapymay also be suggested by your veterinarian.
LIVING AND MANAGEMENT
The overall prognosis is highly variable and will depend on the form of the disease and its location. In addition to following the veterinarian's instructions for the dosage and frequency of the medication, it is vital you provide extra care to once your dog is home. If it still active, your veterinarian may recommend restricting its movements to prevent injury or trauma. Dogs that are immobile, meanwhile, should be allowed to rest in a padded cage or bed, and turned every four hours to prevent bed sores.
Your veterinarian will recommend follow-up exams once or twice a month to conduct neurological tests and to verify that the dog is being adequately nourished.